Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

PART 5. Symptoms guide

Pregnancy can bring with it a host of concerns, everything from acne to morning sickness, to fatigue to heartburn. This guide offers tips and insights to help you get through many of the signs and symptoms of pregnancy that may be uncomfortable or worrisome.

ABDOMINAL DISCOMFORT

Pain in the lower abdomen during the first and second trimesters often stems from normal pregnancy changes. As the uterus expands, the ligaments and muscles that support it stretch. This stretching may cause twinges, cramps or pulling sensations on one or both sides of your abdomen. You may notice the pain more when you cough, sneeze or change position.

An example of abdominal or groin discomfort in midpregnancy is stretching of the round ligament, a cord-like muscle that supports the uterus. The discomfort usually lasts for several minutes and then goes away.

If you’ve had abdominal surgery, you may have pain from stretching or pulling of adhesions, the bands of scar tissue that adhere to the walls of the abdomen or other structures. The increasing size of your abdomen can cause these bands of tissue to stretch or even pull apart, which can be painful.

Lower abdominal discomfort that’s relatively minor and comes and goes irregularly is probably nothing to worry about. If it’s regular and predictable, consider whether you might be entering labor, even if you are still far from your due date.

Prevention and self-care It may help to sit or lie down if abdominal pain is bothering you. You may also find relief by soaking in a warm bath or doing relaxation exercises.

When to seek medical help Pain that’s severe and unrelenting may be a sign of a problem, such as ectopic pregnancy or, later in pregnancy, early labor or a placental abruption. With ectopic pregnancy, which generally causes problems in the first trimester, the pain is often sharp and stabbing. Your abdomen may feel tender. You may have bleeding, nausea and low back pain. In midpregnancy and beyond, abdominal pain accompanied by continuous low back pain may signal a problem. No matter what the cause, call your care provider right away if:

 The pain is severe, persistent or accompanied by fever

 You experience vaginal bleeding, vaginal discharge, gastrointestinal symptoms, dizziness or lightheadedness

 You have contractions, which may feel like a tightening in the abdomen and a sensation similar to menstrual cramps

ABDOMINAL PRESSURE

A feeling of pressure in the lower abdomen and pelvis is probably nothing to worry about, if it’s not accompanied by other symptoms. In the first trimester, this sensation is common. Most likely, you’re feeling your uterus starting to grow. You may also be feeling increased blood flow. In the second or third trimester, the pressure likely has to do with the weight of your baby. Compression of the bladder and rectum and stretching of the pelvic floor muscles also provoke feelings of pressure.

When to seek medical help If the pressure is accompanied by pain, cramping or bleeding early in your pregnancy, contact your care provider. These might be signs and symptoms of miscarriage or an ectopic pregnancy. An ectopic pregnancy occurs when the embryo implants outside the uterus, usually in a fallopian tube. Later in your pregnancy, pressure in the lower abdomen might indicate preterm labor.

Contact your care provider if the pressure lasts for four to six hours or longer or is accompanied by any of the following:

 Pain

 Vaginal bleeding

 A low, dull backache that lasts four hours or longer

 Abdominal cramps

 Regular contractions or uterine tightening

 Watery vaginal discharge

ABDOMINAL TENDERNESS

During pregnancy, your growing uterus stretches the muscles in your abdomen. This may cause the two large parallel bands of muscles that meet in the middle of the abdomen to separate. This separation, called diastasis, can also cause a bulge where the two muscles separate.

For most women, the condition is painless. Other women may experience some tenderness around the bellybutton. The muscle separation can also contribute to back pain.

The condition may first appear during the second trimester, and it may become more noticeable in the third trimester. The problem generally goes away after delivery, but some degree of separation may remain permanently. In subsequent pregnancies, it’s likely to be worse.

Medical care Usually no medical care is needed for abdominal muscle separation. Your care provider can evaluate whether the amount of muscle separation is more than usual. He or she may suggest ways to remedy the separation after your baby is born.

ACNE

Because pregnancy hormones increase secretion of oil from your skin glands, you may develop acne early in your pregnancy. The change is usually temporary and disappears after you give birth.

Prevention and self-care Most acne can be prevented or controlled with good basic skin care. Try the following:

 Wash your face as you normally would. Avoid facial scrubs, astringents and masks because they tend to irritate skin and can make acne worse. Excessive washing and scrubbing also can irritate skin.

 Avoid irritants such as oily cosmetics, hair-styling products or acne concealers. Use products labeled water-based or noncomedogenic, which are less likely to clog pores. If the sun makes your acne worse, protect yourself from direct sunlight.

 Watch what touches your face. Keep your hair clean and off your face. Avoid resting your hands or objects on your face. Tight clothing or hats also can pose a problem, especially if you’re sweating. Sweat, dirt and oils contribute to acne.

Medical care It’s important to exercise caution during pregnancy — even with over-the-counter products. Opinions about using nonprescription products containing benzoyl peroxide are mixed. There’s little research on their safety during pregnancy, although problems haven’t been reported. Erythromycin (Erygel) is often the drug of choice for pregnancy acne. Azelaic acid (Azelex, Finacea) may be another option. Both medications are typically applied to the skin as a lotion or gel and are available by prescription.

ALLERGIES

A stuffy nose in pregnancy is common because pregnancy provokes swelling of the tissues lining the nose. Still, many women experience allergies, either seasonal or year-round, before getting pregnant. Others develop allergy-related symptoms during pregnancy, even if they haven’t had the problem before. In addition to a runny or stuffy nose, you may experience sneezing and itchy, watery eyes.

Many of the usual remedies for these common signs and symptoms — including antihistamines, decongestants and combination medications — have not been proven safe to use during pregnancy. For information on how best to treat allergies during pregnancy, see How do I treat allergies? in Chapter 2.

When to seek medical help If your signs and symptoms are severe or don’t improve with self-care techniques, talk to your care provider.

BABY’S HICCUPS

Starting about midway through your pregnancy, you may occasionally notice a slight twitching or little spasms in your abdomen. What you may be feeling is your baby’s hiccups. Fetal hiccups develop as early as the 15th week of pregnancy. Some fetuses experience hiccups several times a day, and others never get them. After they’re born, most babies have frequent bouts of hiccups. Hiccups are common after a feeding, particularly after burping. No one knows exactly why they occur — in babies or adults — or why babies have them so often.

BABY’S KICKS

The first movements or kicks you feel from the fetus is called quickening. In first pregnancies, this exciting development typically occurs by about 20 weeks’ gestation, although some women experience them a few weeks earlier or later. The movements might feel like a light tapping or the fluttering of a butterfly — some women refer to them as “the butterflies.” At first you might attribute the sensation to gas or hunger pangs.

It’s normal during the second trimester for fetal movements to be somewhat erratic. Later, the kicks and movements usually become stronger and more regular, and you’ll be able to feel them by placing a hand on your lower abdomen. Feeling your baby move is a pleasant way to feel connected to your pregnancy.

As your pregnancy progresses, you’ll probably become aware of your baby’s typical movement patterns. Each fetus has its own pattern of activity and development. The most active time is between 27 and 32 weeks. Activity tends to slow down in the last weeks of pregnancy. If you notice any major changes in your fetus’s activity level after 22 weeks — such as an absence or slowdown of movement for more than 24 hours — contact your care provider.

BACKACHE

Pregnant women are prone to backaches and back pain for a number of reasons. During pregnancy, the joints and ligaments in your pelvic region begin to soften and loosen in preparation for the baby to pass through your pelvis. As your uterus grows, your abdominal organs shift and your body weight is redistributed, changing your center of gravity. In response, you begin to adjust your posture and the ways you move. These compensations often lead to backaches and back pain.

Prevention and self-care To help you feel more comfortable:

 Practice good posture. Tuck your buttocks under, pull your shoulders back and downward, and stand straight and tall. Be aware of how you stand, sit and move.

 Change position often, and avoid standing for long periods of time.

 Avoid lifting heavy objects or children.

 Lift correctly. Don’t bend over at the waist. Instead, squat down, bend your knees, and lift with your legs rather than your back.

 Place one foot on a low stool when you have to stand for a long time.

 Wear supportive, low-heeled or flat shoes.

 Exercise (swim, walk or stretch) at least three times a week. Consider joining a prenatal exercise or yoga class.

 Try to avoid sudden reaching movements or stretching your arms high over your head.

 Sit with your feet slightly elevated.

 Sleep on your side with one knee or both knees bent. Place a pillow between your knees and another one under your abdomen. You may also find relief by placing a regular pillow or a specially shaped body pillow under your abdomen.

 Apply heat to your back. Try warm bath soaks, warm wet towels, a hot water bottle or a heating pad. Some people find relief by alternating ice packs with heat.

 Have a back massage or practice relaxation techniques.

 Wear maternity pants with a low, supportive waistband. Or consider using a maternity support belt.

 Do low back stretches. Rest comfortably on your hands and knees with your head in line with your back. Pull in your stomach, arching your back upward. Hold the position for several seconds, then relax. Repeat five times, gradually working up to 10 repetitions.

When to seek medical help If your back pain is severe, tell this to your care provider. He or she may suggest a variety of approaches, such as special stretching exercises, to alleviate the pain. Also contact your care provider if your back pain lasts four to six hours or longer or if you’re also experiencing any of the following signs or symptoms:

 Vaginal bleeding

 Cramping or abdominal pain

 Passing of tissue from the vagina

 Fever

 Regular uterine contractions (every 10 minutes or more often), which may feel like a tightening in your abdomen

 A feeling of heaviness or pressure in the pelvis or lower abdomen

 Watery discharge (clear, pink or brownish fluid) leaking from your vagina

 Menstrual-like cramps, which may come and go and may be accompanied by diarrhea

BLACK LINE

You have a pale line that runs from your navel to your pubic bone. When you’re not pregnant, it’s often barely noticeable. During pregnancy it can darken, and is sometimes referred to as the “black line” (linea nigra). As with so many other changes that occur during pregnancy, skin darkening is the result of hormones that cause the body to produce more pigment. You may notice other areas where your skin darkens during pregnancy. You can’t prevent skin darkening, but it will fade after delivery.

BLEEDING GUMS

Like the rest of your body, your gums receive more blood flow during pregnancy. This can cause them to swell and soften, and they may bleed a little when you brush your teeth.

Prevention and self-care Don’t neglect your teeth and gums during pregnancy. Brushing, flossing and regular dental exams are important. Get the daily recommended amount of vitamin C from foods or your vitamin supplement to help keep your tissues strong.

When to seek medical help If bleeding is heavy or accompanied by pain, redness or inflammation, make an appointment with your dentist to check for infection and tell your care provider about the problem.

BLURRY VISION

Eye changes during pregnancy can cause slightly blurred vision. Because your body retains extra fluid, the outer layer of your eye (cornea) becomes slightly thicker.

This change may become apparent by the 10th week of pregnancy and persist until about six weeks after the baby is born. In addition, the pressure of fluid within your eyeball (intraocular pressure) decreases during pregnancy. In combination, these changes can cause blurry vision. If you wear contact lenses, particularly hard lenses, you may find them uncomfortable because of these changes.

Prevention and self-care If your contact lenses are uncomfortable, you may want to wear your glasses more often. It’s not necessary to change your eye lens prescription during pregnancy because your vision will return to normal after you give birth.

When to seek medical help If you experience sudden onset of blurry vision, have it evaluated. This is especially critical if you have diabetes. Talk to your care provider about establishing good control of your diabetes, monitoring your blood sugar and about any vision problems you experience.

Blurry vision may also be related to preeclampsia, a disease that produces an increase in blood pressure. Talk to your care provider if you notice a sudden change in your vision, if your vision is very blurry or if you’re seeing spots in front of your eyes.

BREAST DISCHARGE

In the final weeks of pregnancy, you may notice a thin, yellowish or clear substance leaking from one or both nipples. This discharge is colostrum, the yellowish fluid produced by your breasts until your milk comes in.

Colostrum can range in color and consistency, and variations are normal. It may be sticky and yellow at first and become more watery as you approach your due date. The older you are and the more pregnancies you’ve had, the more likely it is you’ll have some breast discharge. But it’s no cause for concern if you don’t leak colostrum — it doesn’t mean you won’t be able to produce breast milk.

If you’re breast-feeding, you’ll produce colostrum for the first few days after your baby is born.

Prevention and self-care If you’re leaking colostrum, you can wear disposable or washable breast pads. It may also be helpful to allow your breasts to air-dry a few times a day and after showers.

When to seek medical help Call your care provider if your nipple discharge is bloody or contains pus or is accompanied by pain. This could indicate a breast abscess or other problem.

BREAST ENLARGEMENT

One of the first signs of pregnancy is an increase in breast size. As early as two weeks after conception, your breasts start to grow and change in preparation for producing milk. Stimulated by the hormones estrogen and progesterone, the milk-producing glands inside your breasts get bigger and fatty tissue increases slightly.

By the end of your first trimester, your breasts and nipples will be noticeably larger, and they may keep growing throughout your pregnancy. Breast enlargement accounts for at least a pound of the weight you gain while pregnant. Your breasts may remain enlarged for a while after your baby’s birth.

Prevention and self-care As your breasts grow, wear a bra that fits well and provides good support to ease the strain on your breasts and back muscles. If your breasts make you uncomfortable at night, try sleeping in a bra. Over the course of your pregnancy, you may need to replace your bras several times as your breasts change in size.

BREAST TENDERNESS

Often the first hint of pregnancy is a change in the way your breasts feel. A few weeks after conception, you may notice tingling sensations in your breasts, and they may feel heavy, tender and sore. Your nipples may be more sensitive.

As with breast enlargement, the primary reason for these changes is increased production of the hormones estrogen and progesterone. Breast tenderness normally disappears after the first trimester.

Prevention and self-care A good support bra that fits well can help alleviate breast tenderness. Try a maternity bra or a larger sized athletic bra — these tend to be breathable and comfortable. At night you may feel more comfortable sleeping in a bra.

BUTTOCK AND LEG PAIN

Pain, tingling or numbness running down your buttock, back or thigh is called sciatica because it follows the course of the sciatic nerve, a major nerve that runs from your lower back down the back of your legs to your feet. Sciatica is caused by pressure on the sciatic nerve from your growing uterus or baby or by relaxed pelvic joints. Lifting, bending and even walking may aggravate sciatica.

Although sciatica is no fun, it’s generally not a cause for concern. When your baby changes position closer to the time of delivery, the pain is likely to ease.

Prevention and self-care Warm baths, a heating pad and switching the side of your body that you sleep on may help with sciatic nerve pain. You may also find relief by changing your position regularly during the day, such as by getting up and moving around once every hour or so.

Swimming is another way to ease the discomfort. Being in the water temporarily takes some of the weight of your uterus off your sciatic nerve.

When to seek medical help Tell your care provider if you’re experiencing sciatica. Seek care if the numbness or pain causes you to trip when you walk or if you feel that you can’t move your foot with equal strength in all directions. It’s fairly common to need physical therapy to help relieve sciatic nerve pain.

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is most often caused by repetitive movements of the hand and wrist. You may be surprised to learn that it’s also common in pregnant women. That’s because hormonal changes, swelling and weight gain can compress the nerve beneath the carpal tunnel ligament in your wrist.

The carpal tunnel ligament is a tough membrane that holds the wrist bones together. A nerve called the median nerve enters the hand through the carpal tunnel, a space between the wrist bones and the carpal tunnel ligament. This passageway is rigid, so any swelling in the area can pinch or compress the median nerve, which supplies sensation to the ball of the thumb, the first two fingers and half of the ring finger.

Symptoms of carpal tunnel syndrome include numbness, tingling, weakness, pain, or a burning sensation in the hands and lower arms. In pregnant women, carpal tunnel syndrome often occurs in both hands.

Prevention and self-care You may be able to relieve the discomfort by rubbing or shaking your hands. The first line of treatment is to wear a wrist splint at night and during activities that make the symptoms worse, such as typing, driving a car or holding a book. Applying cold compresses or heat to your wrists also may help.

Medical care Carpal tunnel syndrome almost always disappears after delivery. In the rare cases when it doesn’t, or when the effects are severe, you may be given steroid injections. Sometimes, minor surgery is needed to correct the problem.

CLUMSINESS

During pregnancy, you may feel like you’re all thumbs — or all feet or elbows. You find yourself stumbling or tripping, bumping into things, dropping everything you pick up. You may worry that you’re going to fall and hurt your baby.

It’s perfectly normal to be clumsier than usual at this time. As your uterus grows, your sense of balance is thrown off. Your usual ways of moving, standing and walking change.

In addition, the hormone relaxin, produced by the placenta, relaxes the binding ligaments that hold the three pelvic bones together. This allows the pelvis to open wider so that the baby’s head can move through the pelvis. It can also contribute to the feeling of clumsiness.

Other factors that may make you clumsier include water retention and lack of dexterity due to carpal tunnel syndrome. Late in pregnancy, your large abdomen can block your view of stairs or hazards on the floor. All of these effects are temporary, and you’ll be back to your old self again after the baby is born.

If you do fall, know that your baby is well protected and probably won’t be harmed. An injury would normally have to be severe enough to hurt you before it would harm your baby.

Prevention and self-care You can’t do much about the physical changes that can make you feel like a bull in a china shop, but you can decrease your chances of falling by taking a few precautions:

 Avoid wearing high heels or pumps. Instead, wear stable, flat shoes with soles that provide good traction.

 Avoid situations that require careful balance, such as perching on ladders and stools.

 Take a little extra time with tasks that require many changes of position.

 Use extra caution when going up or down stairs and in other situations that put you at risk of tripping or falling, such as walking on an icy sidewalk.

When to seek medical help If you fall and strike your abdomen or you’re just worried about the welfare of your baby, see your care provider for reassurance or treatment, if needed. If you fall on your abdomen late in pregnancy, your care provider will likely monitor the baby to be sure that the placenta’s attachment to the uterus wasn’t damaged. Also contact your care provider if after a fall or injury you begin to experience contractions or feel you’ve hurt yourself.

CONSTIPATION

Constipation is one of the most common side effects of pregnancy, affecting at least half of all pregnant women at some point. It’s usually more troublesome in women who were prone to constipation before pregnancy.

When you’re pregnant, an increase in the hormone progesterone causes digestion to slow, so food passes more slowly through the gastrointestinal tract. In the later months, your ever-expanding uterus puts pressure on the lower bowel. In addition, your colon absorbs more water during pregnancy, which tends to make stools harder and bowel movements more difficult.

Other factors that can contribute to the problem include irregular eating habits, stress, changes in environment, and added calcium and iron in your diet. Constipation can give rise to hemorrhoids.

Prevention and self-care The first step in dealing with constipation is to evaluate your diet. Eating fiber-rich foods and drinking plenty of fluids each day will help prevent or ease constipation. Follow these suggestions:

 Eat high-fiber foods, including fresh fruits, raw and cooked vegetables, bran, beans and whole-grain foods, such as whole-wheat bread, brown rice and oatmeal. The age-old remedy of prunes — now marketed as dried plums — can help, as can prune juice.

 Eat small, frequent meals and chew your food thoroughly.

 Drink plenty of fluids, especially water. Aim for eight 8-ounce glasses a day. Drink a glass of water before going to bed.

 Get more exercise. Just adding a little time to your daily walks or other physical activities can be effective.

 Iron supplements can cause constipation. If your care provider has recommended iron supplements and you have constipation, take the iron pills with prune juice. Or you can check to see if it would be OK for you to take a smaller dose of iron.

Medical care If self-care measures don’t work, your care provider may recommend a mild laxative such as milk of magnesia, a bulking agent such as Metamucil or Citrucel, or a stool softener containing docusate. Sometimes, stronger measures are needed, but they should only be used on the advice of your doctor.

Don’t take cod liver oil because it can interfere with the absorption of certain vitamins and nutrients.

CONTRACTIONS

When you’re about to go into labor, you’ll notice an increase in contractions, the tightening and relaxing of the uterine muscles. During labor, the uterus repeatedly contracts, causing the cervix to thin (efface) and open up (dilate) so that you can push your baby out. The contractions gradually dilate the cervix until it’s wide enough for the baby to pass through.

During the early phase of labor, contractions can vary greatly from one woman to another. They might last 15 to 30 seconds at the beginning and be ir-regularly spaced, 15 to 30 minutes apart. Or they might start out fast and then slow down. But they will continue to increase in frequency and duration as the cervix dilates.

Contractions may be relatively painless at first but gradually build in intensity. You may feel like your uterus is knotting up. Or the pain may feel like an aching sensation, pressure, fullness, cramping or a backache.

For more information about contractions and labor, see stages of labor and childbirth in Chapter 14.

FALSE LABOR VS. TRUE LABOR

If you’ve never given birth before, you might assume that having contractions is a sure sign that you’re starting labor. Not necessarily. Most expectant mothers feel occasional painless contractions before they’re actually in labor. Occasionally these can be quite uncomfortable.

In the last weeks of pregnancy, your uterus might start to cramp. When you put your hands on your abdomen, you can sometimes feel your uterus tighten and relax. These mild contractions, also known as Braxton Hicks contractions, are called false labor. Your uterus is warming up, preparing for the big job ahead.

As you approach your due date, false labor contractions become stronger and may be uncomfortable or even painful at times. It can be easy to mistake them for the real thing. The difference between false labor and true labor is that in true labor the contractions cause your cervix to dilate. False labor pains are also irregular, whereas true labor pains follow a regular pattern, gradually getting stronger and more frequent.

One good way to distinguish true labor from false labor is to time the contractions. Using a watch or clock, measure how long each lasts and how long it is from the start of one to the start of the next.

Even after monitoring all these signs, you may not know whether you’re truly in labor. Sometimes the only way to know is to see whether the cervix is dilating, which requires a pelvic exam by your care provider. The start of labor is different for everyone. Some women have painful contractions for days with no cervical changes, while others may feel only a little pressure and a backache.

Prevention and self-care If false labor contractions are making you uncomfortable, take a warm bath and drink plenty of fluids. If you’re in true labor, and walking feels comfortable, go ahead and walk, stopping to breathe through contractions, if necessary. Walking may help your labor. Some women find that as the pain intensifies, rocking in a rocking chair or taking a warm shower helps with relaxation between contractions.

When to seek medical help Monitor your contractions closely to see if they:

 Last at least 30 seconds

 Occur regularly

 Occur more than six times in an hour

 Don’t go away when you move around

If you’re in doubt about whether you are in labor, call your care provider. He or she will want to know what other symptoms you’re feeling, how far apart your contractions are and whether you can talk during them. Go to the hospital if:

 Your water breaks (membranes rupture), even if you’re not having contractions. You may not experience contractions even if your water has broken.

 Your contractions come five minutes apart or closer. Frequent contractions may be a sign of a rapid delivery.

 You have constant, severe pain.

 You have bleeding that’s heavier than spotting.

CRAMPING

Abdominal cramping or pain is not uncommon in pregnancy. However, in early pregnancy, abdominal cramping accompanied by bleeding may be associated with a miscarriage or an ectopic pregnancy.

In midpregnancy and beyond, cramping is often associated with uterine contractions. Occasionally, constipation is the cause. Abdominal pain that’s sudden and severe may be an indication of placental separation. Abdominal pain combined with a fever and vaginal discharge may signal an infection.

When to seek medical help Contact your care provider if cramping or back pain is severe, persistent or accompanied by fever, bleeding or vaginal discharge.

DIZZINESS AND FAINTNESS

Feeling a little dizzy? It’s common for pregnant women to experience lightheadedness, dizziness or faintness. These sensations can result from circulatory changes, such as decreased blood flow to your upper body because of the pressure of your uterus on the blood vessels in your back and pelvis. You’re particularly susceptible to this early in the second trimester, when your blood vessels have dilated in response to pregnancy hormones but your blood volume hasn’t yet expanded to fill them.

Dizziness or faintness may also occur during hot weather or when you’re taking a hot bath or shower. When you’re overheated, the blood vessels in your skin dilate, temporarily reducing the amount of blood returning to your heart.

Low blood sugar (hypoglycemia), common in early pregnancy, also can cause dizziness, as can having too few red blood cells (anemia). Finally, stress, fatigue and hunger can make you feel dizzy or faint.

Prevention and self-care To prevent faintness and dizziness:

 Move slowly as you get up from a lying or sitting position.

 Move or walk at a slower pace. Take frequent rest breaks.

 Avoid standing for long periods of time.

 Avoid lying flat on your back. Instead, lie on your side, with a pillow tucked under your hip.

 Avoid getting overheated. Stay away from warm, crowded areas. Dress in layers. Make sure your bath or shower isn’t too hot. Leave the door or window open to keep the room from getting too hot.

 Eat several small meals or snacks each day instead of three large meals. Munch on snacks such as dried or fresh fruits, whole-wheat bread, crackers or low-fat yogurt.

 Stay physically active to help with your lower body circulation. Good activities include walking, water aerobics and prenatal yoga.

 Drink plenty of fluids, particularly early in the day. Sports drinks may be most effective.

 Eat foods that are rich in iron, such as beans, red meat, green leafy vegetables and dried fruits. Also take iron supplements or prenatal vitamins as recommended by your care provider.

When to seek medical help It’s always a good idea to tell your care provider if you’ve been feeling faint or dizzy. If faintness or dizziness is severe and occurs with abdominal pain or vaginal bleeding, it may be a sign of ectopic pregnancy, in which the fertilized egg attaches outside the uterus.

DREAMS

You’re being grabbed around the middle by a gorilla … flying over tall buildings … talking to your newborn, who is talking back! Vivid dreams and nightmares are common during pregnancy. Dreams may be the mind’s way of processing unconscious information. During this time of emotional and physical changes, your dreams may seem more intense and strange. You may find that you’re dreaming more frequently or remembering your dreams more clearly when you wake up.

You may have anxiety dreams or nightmares. Try not to be disturbed about them. They reflect your apprehension and excitement about this major life change.

One way to enjoy your heightened dream world is to record your dreams in a dream journal. Writing about dreams can be a way to reflect on and come to terms with your experiences. If disturbing dreams or nightmares are causing you distress, it might be helpful to talk with a therapist or counselor to help discover what’s troubling you.

ENLARGED VEINS

During pregnancy, veins throughout your body become larger to accommodate increased blood flow to your baby. These enlarged vessels often show up as fine bluish or purplish lines under the skin, most often on the legs and ankles. Blood vessels in the skin on your breasts also become more visible and appear as blue or purplish lines. These lines usually disappear after pregnancy.

Some women develop varicose veins — protruding, swollen veins, particularly in the legs. The veins may also extend into the vulva, where they can be quite painful. Varicose veins usually surface late in pregnancy, when the uterus exerts greater pressure on the veins in the legs and lower body.

EXCESSIVE SALIVATION

Along with feeling nauseated, you may be experiencing excessive salivation. This is called ptyalism. It’s a somewhat unusual side effect of pregnancy, but very real and can be annoying. However, it’s not an indication that anything is wrong. It may be that you’re not really producing more saliva, but that you’re not swallowing as much as usual because of nausea.

Prevention and self-care It may be helpful to cut back on starchy foods. Usually, when your nausea begins to decrease, this problem tends to ease up.

When to seek medical help Excessive salivation by itself doesn’t require medical care. However, if you have pain while swallowing or difficulty swallowing, tell your care provider.

EYE CHANGES

Some of the changes your body undergoes during pregnancy can affect your eyes and your vision. During pregnancy, the outer layer (cornea) of the eyes becomes a little thicker, and the pressure of fluid within your eyeballs (intraocular pressure) decreases by about 10 percent. These changes occasionally result in slightly blurred vision. In addition to blurry vision, you may experience other changes:

 Refractive changes. Changes in hormone levels appear to temporarily alter the strength you need in your eyeglasses or contact lenses.

 Dry eyes. Some pregnant women develop dry eyes, which may involve a stinging, burning or scratchy sensation, increased eye irritation or fatigue, and difficulty wearing contact lenses.

 Puffy eyelids. Because of water retention during pregnancy, you may have puffiness around the eyes. Puffy eyelids can interfere with peripheral vision.

Diabetes complications such as diabetic retinopathy — which damages the retina of your eye — can worsen during pregnancy. It’s essential to have your eyes examined during pregnancy if you have diabetes. Women with high blood pressure (hypertension) also are susceptible to vision problems. High blood pressure during pregnancy also requires close observation.

Prevention and self-care To lessen the discomfort of dry eyes, use lubricating eyedrops, also referred to as artificial tears. Lubricating eyedrops are safe to use during pregnancy. If your contacts are uncomfortable because of dry, irritated eyes, try cleaning the lenses with an enzymatic cleaner more often. If they remain uncomfortable, don’t worry. Your eyes will likely return to normal a few weeks after delivery.

When to seek medical help Contact your care provider immediately if you have a new onset of blurred vision or blind spots at any time. If you have diabetes or high blood pressure, work with your care provider to closely monitor your vision.

FACIAL SKIN DARKENING

More than half of all pregnant women develop mild skin darkening on the face. Commonly called the mask of pregnancy, this brownish coloration is also known as chloasma or melasma. It can affect any woman who’s pregnant, though women who are dark haired and fair skinned are more susceptible. Melasma usually appears on sun-exposed areas of the face, such as the forehead, temples, cheeks, chin, nose and upper lip. It can occur on both sides of the face (symmetrical), but often develops in just one area.

Melasma is often aggravated or intensified by exposure to sunlight or other sources of ultraviolet (UV) light. The condition usually fades after delivery, although it may not fade completely, and it can return with additional pregnancies or sun exposure.

Prevention and self-care Because exposure to sunlight often worsens skin darkening, protect yourself from getting too much sun:

 Always wear sunscreen with a sun protection factor (SPF) of 15 or greater when you’re outdoors, whether it’s sunny or cloudy. The sun’s UV rays can reach your skin even when the sky is overcast.

 Avoid the most intense hours of sunlight, during the middle of the day.

 Wear a wide-brimmed hat that shades your face.

Medical care Avoid creams or other agents that bleach the skin. If your skin darkening is extreme, your care provider or a dermatologist may prescribe a medicated ointment. If melasma persists long after you’ve delivered your baby, consult a dermatologist. He or she may recommend a medicated cream or ointment or a chemical peel.

FATIGUE

“I’m so tired!” This is one of the most common comments of pregnancy. During the early months, your body is working hard — pumping out hormones, producing more blood to carry nutrients to the fetus, speeding your heart rate to accommodate the increased blood flow, and changing the way you use water, protein, carbohydrates and fat. During the last couple of months of pregnancy, carrying the extra weight of the baby is tiring.

In addition to physical changes, you’re dealing with a range of feelings and concerns that may sap your energy and disturb sleep. It’s natural to have conflicting feelings about a pregnancy, whether it’s planned or unplanned, your first or your fourth. Even if you’re overjoyed, you’re probably facing added emotional stresses. You may have fears about whether the baby will be healthy, anxiety about how you will adjust to motherhood and concerns about increased expenses. If your job is demanding, you may worry about being able to stay productive throughout your pregnancy. These concerns are normal and natural.

Rarely, fatigue is related to a medical condition. If your fatigue is severe, discuss it with your care provider.

Prevention and self-care Fatigue is a sign from your body that you need extra rest. Don’t push yourself. Here are some ways to keep fatigue from getting the best of you:

 Rest. Accept the fact that you need extra rest during these nine months, and plan your daily life accordingly. Take naps when you can during the day. At work, finding time to sit back comfortably with your feet up can renew your energy. If you can’t nap during the day, maybe you can take one after work or before dinner or your evening activities. If you need to go to bed at 7 p.m. to feel rested, do it.

 Avoid taking on extra responsibilities. Cut down on volunteer commitments and social events if they’re wearing you out.

 Ask for the support you need. Get your partner or other children to help out as much as possible.

 Exercise regularly. Regular physical activity will increase your energy level. Moderate exercise, such as walking for 30 minutes a day, can help you feel more energized.

 Eat well. Eating a nutritious, balanced diet is more important now than ever. Make sure you’re getting enough calories, iron and protein. Fatigue can be aggravated if your diet is short on iron or protein.

Medical care No medications for fatigue are safe or effective during pregnancy. You also want to avoid stimulants such as caffeine, which may be harmful in high doses.

FEELING WARM

Overheated? It’s not just because you’re getting bigger or because the weather is warm. During pregnancy, your metabolism — the rate at which your body expends energy at rest — speeds up. And you’re probably perspiring more as a result of needing to lose all the heat your baby is making. This can leave you feeling too warm, even in winter.

Prevention and self-care It’s important to avoid getting overheated while you’re pregnant. Follow these tips to keep cool:

 Drink plenty of water and other fluids. Carry a water bottle with you.

 Dress lightly in breathable fabrics such as cotton.

 Avoid exercising outside in the warmest part of the day. Take a walk before breakfast or after dinner, or go to a fitness center.

 Try and stay out of the sun as much as possible.

 Go for a swim, or take a tepid or cool shower or bath.

 When the temperature is over 90 F, stay in air-conditioned environments as much as possible.

FLUID LEAKAGE

When the amniotic sac leaks or breaks before labor begins, the fluid that has been cushioning the baby comes out in a trickle or gush. This dramatic event is known as the water breaking, or the rupture of membranes. Only about 10 percent of women experience this beforelabor. Your membranes are more likely to rupture sometime during labor, often during the second stage. When it happens, labor usually starts or becomes more intense.

Contact your care provider if your water breaks. Most care providers want to evaluate you as soon as it happens because there’s a risk of infection after the membranes rupture. Generally, unless the baby is very premature, it’s best that the baby is born within about 24 hours. Let your care provider know if the fluid is anything other than clear and odorless. A greenish or foul-smelling fluid could be a sign of uterine infection.

If you’re uncertain whether the leaking fluid is amniotic fluid or urine, have it checked by your care provider. Many pregnant women leak urine during the later stages of pregnancy. In the meantime, don’t do anything that could introduce bacteria into your vagina, such as having sex or using tampons.

FOOD AVERSIONS

Early in pregnancy, you may find yourself repulsed by certain foods, such as fried foods or coffee. Just the smell of these foods may send a wave of nausea through your stomach. You may have a mildly metallic taste in your mouth that contributes to the problem. Most food aversions disappear or weaken by the fourth month of pregnancy.

Food aversions, like so many other complaints of pregnancy, can be chalked up to hormonal changes. Most pregnant women find that their food tastes change somewhat, especially in the first trimester, when the hormones are having the strongest impact. Food aversions can be accompanied by a heightened sense of smell and, at times, increased salivation, making your distaste even more acute.

Prevention and self-care As long as you continue to eat a healthy diet and get all the nutrients you need, appetite changes aren’t a cause for concern. If your aversion is to coffee or tea, that works in your favor because you’ll find it easier to give up these foods. But if your aversion is to healthy foods such as fruits or vegetables, you’ll have to find other sources of the nutrients that these foods provide.

FOOD CRAVINGS

You may not have had the classic pickles-and-ice-cream craving, but chances are you’ve had a strong desire for certain types of food during your pregnancy. Most expectant mothers experience food cravings, which are likely caused by pregnancy hormones.

You may wonder if a food craving is a signal from your body that you need the nutrients in that food; however, a craving for ice cream doesn’t mean your body needs the saturated fat. Similarly, if you’re not in the mood for citrus fruits, that doesn’t mean you don’t need vitamin C.

Most food cravings disappear or weaken by the fourth month of pregnancy. Cravings that last longer could be a sign of iron deficiency and the anemia that results. Discuss this with your care provider if strong cravings continue into the second trimester.

Prevention and self-care As long as you’re eating a healthy diet and getting the nutrients you need, you don’t have to worry about changes in your food tastes. It’s OK to indulge occasionally. However, try not to use your cravings as an excuse for overeating. You can respond to cravings without compromising your own or your baby’s nutritional needs.

Try to satisfy your food urges without filling up on empty calories. For example, if you crave chocolate, choose chocolate frozen yogurt rather than ice cream or a frozen chocolate bar. If you crave a burger and fries, try a sub sandwich and baked chips instead. In addition, try diverting your attention by taking a walk, reading a good book or calling a friend.

When to seek medical help Rarely, some pregnant women have a craving for unusual, inedible and possibly harmful substances. These may include items such as clay, laundry starch, dirt, baking soda, ice chips or frost from the freezer, ashes, or road salt. Such uncommon cravings result from a disorder known as pica. It can be dangerous and may be caused by an iron deficiency. If you experience a craving to eat something that isn’t food, report it to your care provider.

FORGETFULNESS

You misplace your keys, forget an appointment, can’t focus on your work. If you feel like you’ve turned into a scatterbrain since becoming pregnant, don’t worry. During pregnancy, some women become more forgetful or absent-minded or have trouble concentrating. These symptoms, similar to what some women experience premenstrually, are a temporary effect of hormonal changes. Sometimes, forgetfulness can persist for a while after delivery.

Prevention and self-care To help yourself feel more in control:

 Accept that being a little absent-minded during pregnancy is normal. Getting uptight about it may make it worse. Now’s the time to have a sense of humor.

 Reduce the stresses in your life as much as possible.

 Keep lists at home and at work so that you don’t forget things you need to do. Some women benefit from using an electronic organizer.

GAS AND BLOATING

Gas, bloating, flatulence — more fun aspects of being pregnant! Under the influence of pregnancy hormones, your digestive system slows down. Food moves more slowly through your gastrointestinal tract. This slowdown serves an important purpose: It allows nutrients more time to be absorbed into your bloodstream and to reach the fetus. Unfortunately, it can also cause bloating and gas. The problem may be aggravated during the first trimester, when many women have a tendency to swallow air in response to nausea.

Prevention and self-care To minimize the amount of gas and bloating you experience during pregnancy, follow these suggestions:

 Keep your bowels moving. Constipation is a common cause of gas and bloating. To avoid it, drink plenty of liquids, eat a variety of high-fiber foods and stay physically active on a regular basis.

 Eat small, frequent meals, and don’t overfill your stomach.

 Eat slowly. When you eat in a hurry, you’re more likely to swallow air, which can contribute to gas. Take a few deep breaths before meals to relax.

 Avoid gas-producing foods. These vary from one person to another, but some common culprits include beans, cabbage, broccoli, cauliflower, Brussels sprouts, onions, carbonated beverages, fried foods, greasy or high-fat foods, and rich sauces. Some of these foods are good sources of nutrients. Instead of giving them up, try eating them in small amounts.

 Don’t lie down immediately after eating.

Medical care There’s some concern about using over-the-counter medications for gas and bloating, so talk with your care provider before taking medications. If you’re uncomfortable — the problem is more than a social nuisance — your care provider can suggest alternative treatment approaches.

GUM DISEASE

An old saying has it that “a woman loses one tooth with every pregnancy.” While that’s clearly a tale from the days before professional dental care, it’s true that you’re more susceptible to dental problems when you’re pregnant. The oral changes of pregnancy are linked to an increased amount of plaque that coats your teeth. Hormonal changes also make your gums more susceptible to the damaging effects of plaque. If plaque hardens, it turns into tartar. When plaque and tartar build up around the base of your teeth, they can irritate your gums and create pockets of bacteria between your gums and teeth. This condition is called gingivitis, a form of gum disease. Gingivitis usually starts in the second trimester.

Prevention and self-care Because your teeth are more susceptible to the harmful effects of bacteria while you’re pregnant, it’s important to keep up good dental hygiene. Follow these steps to keep your gums healthy:

 Brush your teeth with flouride toothpaste at least twice a day and after each meal.

 Rinse your mouth with water or with anti-plaque and fluoride mouthwashes.

 Floss your teeth thoroughly each day. Flossing removes plaque between your teeth and helps massage your gums. Waxed and unwaxed floss are both fine.

 Even if you’re not having problems with your teeth or gums, schedule an appointment to have your teeth checked and cleaned at least once during your 10 months.

Medical care If you have severe gum disease, you’ll want to have it treated. Contact your dentist and your care provider if you have signs and symptoms of periodontitis:

 Swollen or recessed gums

 An unpleasant taste in your mouth

 Bad breath

 Loose teeth or a change in your bite

 Drainage of pus around one or more teeth

HEADACHES

Many pregnant women are troubled by headaches. Early in pregnancy, increased blood circulation and hormonal changes can cause headaches. Other possible causes include stress or anxiety, fatigue, nasal congestion, eyestrain, and tension. If you suddenly eliminated or cut down on caffeine when you learned you were pregnant, this “withdrawal” can cause headaches for a few days.

If you already have problems with migraines, during your pregnancy they may stay the same, improve or worsen. They might be worse in the first trimester, then improve in the second.

Prevention and self-care One way to avoid getting headaches is to determine what triggers them and avoid those things. Triggers may include cigarette smoke, stuffy rooms, eyestrain and certain foods. Here are some other suggestions for minimizing headaches:

 Get plenty of sleep each night, and rest during the day when possible.

 Drink plenty of liquids.

 Soothe a sinus headache by applying a warm washcloth to the front and sides of your face, around your nose, eyes and temples. If you feel a tension headache coming on, apply an ice pack or cold compress to your forehead and the back of your neck.

 Take a warm shower or bath.

 Massage your neck, shoulders, face and scalp, or ask your partner or a friend to give you a massage.

 Practice relaxation techniques and exercises, such as relaxed breathing and medittion.

 Minimize the stresses in your life. If you’re under more stress than you feel you can handle, it might be helpful to talk to your care provider.

When to seek medical help Contact your care provider right away if you’re having headaches that are severe, persistent or frequent, or that are accompanied by blurry vision or other vision changes. Also talk to your care provider before taking pain relievers or headache medications. If you have migraines, talk to your care provider about how to manage them during pregnancy. He or she may tell you to avoid certain medications.

HEARTBURN

More than half of all pregnant women get heartburn, and for many it’s their first experience with it. Heartburn, also called gastroesophageal reflux disease (GERD), actually has nothing to do with your heart. It’s caused by the backward flow of stomach contents passing up into the esophagus. When this happens, stomach acids irritate the lining of the esophagus. The resulting burning sensation at about the level of the heart gives the condition its misleading name.

Heartburn is more common during pregnancy because pregnancy hormones cause your digestive system to slow down. This gives nutrients more time to be absorbed into your bloodstream and to reach the fetus, but it also takes longer for your stomach to empty. The result is often indigestion and heartburn. In addition, during the later months of pregnancy, your growing uterus continually pushes on your stomach, moving it higher and compressing it. This pressure can force stomach acids upward, causing heartburn.

Prevention and self-care Heartburn is unpleasant, but you can take steps to prevent it or treat it:

 Eat more-frequent but smaller meals. For example, have five or six small meals a day rather than three large meals.

 Some foods are more likely to irritate your stomach and esophagus than are others. Determine which foods give you heartburn, and avoid them. Stay away from fatty, greasy or fried foods, coffee and tea, chocolate, peppermint, alcohol, carbonated beverages, very sweet foods, acidic foods such as citrus fruits and juices, tomatoes and red peppers, and highly spiced foods.

 Drink plenty of fluids, especially water.

 Sit with good posture when eating. Slouching can put extra pressure on your stomach.

 Wait an hour or longer after eating before you lie down.

 Avoid eating for two to three hours before you go to bed. An empty stomach produces less acid.

 Avoid movements and positions that seem to aggravate the problem. When picking things up, bend at the knees, not the waist.

 When resting or sleeping, prop yourself up on pillows to elevate your head and shoulders, or raise the head of your bed four to six inches.

When to seek medical help If heartburn becomes a significant problem, see your care provider. Don’t take any antacid or acid blocker without consulting your care provider first. Antacids can be high in salt and can increase fluid buildup in body tissues during pregnancy. You also want to avoid heartburn medications that contain aspirin, such as Alka-Seltzer.

HEMORRHOIDS

Hemorrhoids during pregnancy are caused by increased blood volume and pressure from the uterus on the veins in your rectum. The veins may enlarge into firm, swollen pouches underneath the mucous membranes inside or outside the rectum. Hemorrhoids may occur for the first time during pregnancy or become more frequent or severe.

Constipation also can contribute to hemorrhoids because straining can enlarge the rectal veins. Constipation is common throughout pregnancy, especially during the later months, when your uterus may push against your large intestine.

Hemorrhoids can be painful, and they may bleed, itch or sting, especially during or after a bowel movement. Usually, hemorrhoids recede or disappear after you give birth.

Prevention and self-care The best way to deal with hemorrhoids is to avoid constipation. To prevent hemorrhoids or to ease their discomfort, try the following tips:

 Eat high-fiber foods, such as fruits and vegetables, and drink plenty of fluids.

 Exercise regularly.

 Avoid straining during bowel movements. Put your feet on a stool to reduce straining, and avoid sitting on the toilet for long periods of time.

 Keep the area around your anus clean. Gently wash the area after each bowel movement. Pads of witch hazel may help relieve pain and itching. You can refrigerate the pads, which may be more soothing when applied cold.

 Try warm soaks in a tub or sitz bath. Add an oatmeal bath formula or baking soda to the water to combat itching.

 Avoid sitting for long periods, especially on hard chairs.

Medical care Consult your care provider to develop a plan to manage hemorrhoids during pregnancy. If self-care measures don’t work, your care provider may prescribe a cream or an ointment that can shrink them.

HIP PAIN

It’s not uncommon to feel some soreness or pain in your hips during pregnancy, especially when you’re sleeping on your side at night. In preparation for the birth of your baby, the connective tissues in your body soften and loosen up. The ligaments in your hips stretch, and the joints between the pelvic bones relax. The greater flexibility makes it easier for the baby to pass through the pelvis at birth.

In late pregnancy, your heavier uterus might contribute to changes in your posture, adding to your hip soreness. Hip pain is often stronger on one side because the baby tends to lie more heavily to one side. If you have other young children you carry on your hip, this may also contribute to hip pain.

Prevention and self-care Exercises to strengthen your lower back and abdominal muscles may ease hip soreness. Warm baths and back and hip massages also may help. Try elevating your hips above the level of your chest a few minutes at a time.

HUNGER

Feeling hungrier than usual is normal — most women experience an increase in appetite throughout pregnancy. Some women have the opposite problem: a lack of appetite due to nausea. Or you may be hungry for a certain type of food, such as fruits, chocolate, mashed potatoes or cereal. Especially during the first trimester, hormonal changes can cause changes in appetite. The main thing is to eat a variety of nutritious foods. If you’re frequently hungry, eat small meals throughout the day.

INCREASED HEART RATE

Throughout pregnancy your heart pumps more blood than it does normally. This helps meet the fetus’s needs for oxygen and nutrients, which are carried in the blood through the placenta.

As the heart pumps additional blood, your heart rate speeds up as well. Your heart beats progressively faster throughout pregnancy — what may feel like a pounding in your chest. By the third trimester, your heart rate may be 20 percent faster than it was before you were pregnant.

Medical care Because of increases in blood volume, some pregnant women develop heart murmurs. Their occurrence is normal because more blood is flowing through your heart valves. Occasionally, however, the murmur may sound different enough that your care provider will investigate the condition further.

INSOMNIA

You go to bed exhausted, sure that you’ll nod off the minute your head hits the pillow. Instead, you find yourself wide awake and watching the minutes tick by. Or, you wake up at four in the morning, unable to fall back asleep. Insomnia is very common during pregnancy. There are many reasons why.

Although many women sleep more during the first trimester than before they were pregnant, hormonal changes can make it harder for some women to sleep through the night. As your growing uterus puts pressure on your bladder, the frequent need to urinate also can get you out of bed at night to go to the bathroom.

As the baby gets larger, you may find it harder to find a comfortable position for sleeping. An active baby also can keep you awake. Heartburn, leg cramps and nasal congestion are other common reasons for disturbed sleep in the later months of pregnancy.

Then there’s the natural anticipation, excitement and anxiety you’re bound to feel about your baby’s arrival. You may have worries about the health of the baby and the changes the baby is going to create in your life. These feelings can make it hard to relax your mind and body. You may have frequent and vivid dreams about birth and the baby, which can also contribute to insomnia.

Prevention and self-care If you have difficulty falling or staying asleep, try these suggestions:

 Start winding down before going to bed. Take a warm bath or do relaxation exercises. Ask your partner for a massage.

 Make sure your bedroom is at a comfortable temperature for sleeping and that it’s dark and quiet.

 Cut down on your fluids in the evening before bed.

 Avoid foods or beverages containing caffeine.

 Exercise regularly, but avoid overexertion from doing too much.

 The best position for sleeping in late pregnancy is on your left or right side, with your legs and knees bent. Lying on your side takes pressure off the large vein that carries blood from your legs and feet back to your heart. This position also takes pressure off your lower back. Use one pillow to support your abdomen and place another between your knees to support your upper leg. You can also try placing a bunched-up pillow or rolled-up blanket in the small of your back. This will help relieve pressure on the hip you’re lying on.

 If you can’t sleep, get up and read, listen to relaxing music, work on a hobby or do some other calming activity.

 If possible, take short naps during the day to make up for missed sleep at night.

Medical care If insomnia is frequent and is causing you problems, talk to your care provider. If ongoing disturbing dreams or nightmares are causing you distress, it might be helpful to talk with a therapist or counselor.

IRRATIONAL FEARS

All women and men have some fears, especially about the health and condition of their babies. You may also have fears about labor — such as not making it to the hospital in time, or having an emergency cesarean delivery.

It’s normal to feel a moderate amount of worry, but fears that are all-consuming and interfere with your day-to-day functioning may need attention.

Prevention and self-care Sit down and make a list of your fears. Share them with your partner or labor companion. Talking about your fears can lighten an unnecessarily heavy emotional load. You might also want to talk with your care provider and with other expectant mothers, perhaps in a pregnancy class or online chat room. When you voice your fears, they have less power over you.

Childbirth preparation classes offer a unique opportunity to talk with other couples who may have the same worries. The instructor also can help address fears about giving birth.

When to seek medical help If your fears are interfering with your daily functioning, talk with your care provider. Your care provider’s reassurance may help you let go of some of your fears and get on with caring for yourself and your baby.

ITCHINESS

Some pregnant women experience itchiness, which usually goes away after birth. The itchiness may be on your abdomen or all over your body, and it may accompany patches of red, flaky rash. Skin stretching over the abdomen probably accounts for some of the itching and flaking.

A common skin problem called pruritic urticarial papules and plaques of pregnancy (PUPPPs) also can occur. Women affected with this condition break out with itchy bumps or welts, called papules or plaques, on the abdomen, thighs, buttocks or arms.

Rarely, a condition called cholestasis of pregnancy can cause itchiness. In this con-dition, bile isn’t cleared from the liver as quickly as it should, and components build up in the skin, triggering severe itching. Because there are fetal risks associated with cholestasis, let your care provider know if you experience severe itching.

Prevention and self-care Scratching isn’t the best way to relieve an itch. Try these measures:

 Moisturize your skin with lotion, creams or oils.

 Wear loose clothing made from natural fibers, such as cotton.

 Use an oatmeal bath formula.

 Avoid getting overheated because you’ll itch more if you’re too warm.

When to seek medical help If self-care measures don’t provide relief for your itches, your care provider may prescribe medication or other treatment techniques that can help. If severe itching develops late in your pregnancy, your care provider may order blood tests to check your liver function.

LEG CRAMPS

Cramps in the lower leg muscles are fairly common in the second and third trimesters of pregnancy. They most frequently occur at night, and they may disrupt your sleep. Although the exact cause of leg cramps is unknown, slow blood return associated with the pressure of the baby on your leg veins may be responsible.

Prevention and self-care Here are some tips for relieving the discomfort of leg cramps or calf tenderness:

 Try exercises to stretch your calf muscles, particularly before bed.

 Stretch the affected muscle. Try straightening your knee and gently flexing your foot upward.

 Walk. You may find it uncomfortable at first, but walking helps relieve the cramping.

 Wear support hose, especially if you stand a lot during the day.

 Take frequent breaks if you sit or stand for long periods.

 Massage your calves.

 Try resting with your legs up on pillows or the arm of a sofa.

 Wear shoes with low heels.

When to seek medical help If leg cramps persist, talk to your care provider. They might be caused by a circulation problem. Contact your care provider right away if you notice redness, swelling, an increase in pain or if you have a history of a blood clots or a blood-clotting disorder.

MOOD SWINGS

One minute you’re giddy with happiness. A few minutes later, you feel like crying. Especially in the first trimester, mood swings are common. Your emotions may span from exhilaration and joy to exhaustion, irritation, weepiness or depression. If you’ve typically experienced premenstrual syndrome, you may have more extreme mood swings when you’re pregnant.

What causes this moodiness? Some of it may be linked to pregnancy-related discomforts such as nausea, frequent urination, swelling and backache, all of which can interfere with sleep. Fatigue, changing sleep patterns and new bodily sensations can all influence how you feel. You may also be adjusting to a new body image.

Mood changes are also related to changing hormones and changes in your metabolism. Just as fluctuations in progesterone, estrogen and other hormones are linked to the blues many women feel before their periods or after giving birth, these hormonal changes may play a role in the mood changes of pregnancy.

In addition, pregnancy can bring a number of new stresses to your life.

Prevention and self-care Knowing more about why you’re feeling moody, and realizing these mood swings are temporary, can help you weather your moody storms. These tips may help you prevent mood swings altogether:

 Keep healthy and fit by eating nutritious foods, getting plenty of sleep and exercising regularly. Exercise is a natural stress reducer and can help prevent backache, fatigue and constipation.

 Boost your support network. This may include your partner, family, friends and a support group. A good support network can provide emotional support and help with tasks around the home.

 Find time to relax each day. You might try techniques such as meditation, guided imagery and progressive muscle relaxation. These kinds of relaxation exercises are often taught in childbirth classes.

 Accept that you may not be able to do everything you did before getting pregnant. Cut back on unnecessary activities that may be contributing to stress or discomfort.

When to seek medical help Exaggerated mood swings that last more than two weeks could be a sign of depression. Mild depression is quite common in pregnant women. You may be experiencing depression if you’re consistently feeling sad, weepy or worthless, your appetite and sleeping habits have changed, you’re having difficulty getting your work done, and you take less pleasure in things you normally enjoy.

If your mood swings seem to be more than you can handle or if you have signs and symptoms of depression, talk to your care provider. Depression can be treated.

MORNING SICKNESS

Morning sickness is one of the classic signs of pregnancy. It refers to nausea and vomiting that often accompany pregnancy, especially in its early stages. For more information on morning sickness, see coping with morning sickness in Chapter 5.

MUCOUS DISCHARGE

As you approach your delivery date, you may notice an increase in mucous discharge from your vagina. During pregnancy, the opening of the cervix becomes blocked with a thick plug of mucus that keeps bacteria and other germs from entering the uterus. As you get closer to labor, your cervix begins to thin and relax, and the mucous plug may loosen, causing discharge to increase and thicken. The plug is sometimes dislodged as thick, stringy or blood-tinged mucus.

Prevention and self-care Mucous discharge is normal toward the end of pregnancy. If you need something to absorb the flow, use sanitary napkins. Keep your genital area clean, and wear cotton underwear. Avoid tight or nylon pants, and don’t use perfume or deodorant soap in the genital area.

When to seek medical help Call your care provider if your discharge is foul smelling, yellow or green or causes itching or burning. These could be signs of an infection. Mucous discharge before 35 weeks could be a sign of preterm labor. Report it to your care provider.

NAVEL SORENESS

Along with the other aches and pains associated with your expanding uterus, your bellybutton (navel) area may feel tender or sore. This tenderness might be most noticeable as you pass the 20th week of pregnancy and then subside as your belly grows. You may feel most uncomfortable when sitting upright. In some cases, as the skin around the navel continues to stretch, it may become increasingly tender and irritated by clothing and contact. The stretching and separation of the two large bands of muscles that run along your abdomen also can cause some soreness around your navel.

Prevention and self-care To relieve tenderness around your navel, use the pads of your fingers to massage your abdomen in a circular pattern, or ask your partner to do this for you. Apply a cold or warm compress to your bellybutton to soothe it. Sometimes, placing a large bandage over your naval can relieve irritation from clothing and other contact. If pain around your navel is accompanied by severe loss of appetite, this could be a more serious problem. Contact your care provider.

NESTING

As your due date nears, you may find yourself cleaning cupboards, washing walls, organizing your closets, cleaning out the garage, sorting the baby’s clothes or decorating the nursery. The powerful urge to clean, organize and decorate before the baby arrives is called the nesting instinct. It’s usually strongest just before delivery.

Nesting gives you a sense of accomplishment before birth and allows you to come home afterward to a clean house. This desire to prepare your home can be useful because it’ll give you more time later to recover and spend time with your baby. But don’t overdo it and wear yourself out. You’ll need your energy for the hard work of labor.

NIPPLE DARKENING

Like other areas of your skin, the skin on or around your nipples may darken during pregnancy. Skin darkening is the result of pregnancy hormones, which cause your body to produce more pigment. The increased pigment isn’t distributed evenly like a smooth tan, but often appears as splotches of color.

Darkening of the nipples and other areas of skin typically fades after delivery. In the meantime, avoid using agents that bleach the skin.

NOSEBLEEDS

Some women experience nosebleeds during pregnancy, even though they never or rarely did before. With the extra blood flowing throughout your body, the tiny blood vessels lining the nasal passages are more fragile and likely to rupture.

Prevention and self-care To stop a nosebleed:

 Sit up and keep your head elevated. Pinch the soft parts of your nose together between your thumb and index finger.

 Press firmly but gently, compressing the pinched parts of the nose toward the face.

 Hold this position for five minutes.

 Lean forward to avoid swallowing the blood, and breathe through your mouth.

To prevent a nosebleed:

 Be gentle when blowing your nose, and don’t try packing your nose with gauze.

 Dry air may make you more susceptible to nosebleeds. Use a humidifier during the winter months.

When to seek medical help Call your care provider if the nosebleed persists, if you have high blood pressure or if it occurs after a head injury.

PELVIC PRESSURE

In the last weeks of pregnancy, you may feel a sense of pressure, heaviness, soreness or tenderness in your pelvic area. This is caused by the baby pushing into the pelvis and compressing the bladder and rectum. In addition, the baby is likely to compress some veins and cause blood to pool. Finally, the bones of the pelvis are being pushed outward a bit, causing further discomfort.

A feeling of pelvic pressure before the 37th week of pregnancy could be a sign of preterm labor, particularly if the pressure seems to radiate toward your thighs, or you feel as if the baby is pushing down.

Prevention and self-care If you experience pelvic pressure in the last weeks of pregnancy, you may find some relief by resting with your feet up. Kegel exercises also may help with pelvic soreness: Squeeze the muscles around your vagina tightly, as if you were stopping the flow of urine for a few seconds, then relax. Repeat 10 times.

When to seek medical help Call your care provider or go to the hospital if you think you’re experiencing preterm labor. In addition to pelvic pressure, other signs and symptoms of preterm labor include:

 Cramping in the lower abdomen. The cramps may be similar to menstrual cramps and may be continuous or come and go.

 A low, dull backache that radiates to the side or front of your body and isn’t relieved by any change in position.

 Contractions every 10 minutes or more often.

 Clear, pink or brownish fluid leaking from your vagina or vaginal bleeding.

Your care provider may ask you to come into the office or go to the hospital, or you may be advised to rest on your left side for an hour to see if the symptoms lessen or go away.

PERINEAL ACHING

During the last month of pregnancy, after the baby has dropped into the pelvic cavity, you may feel a sensation of increased pressure or aching in the perineal area — the area between the vulva and the anus. This dropping, referred to as lightening, indicates that the presenting part of the baby, usually the head, is engaged in the upper portion of the pelvis. If this is your first pregnancy, baby may drop down into the birth canal several weeks before labor. If you’ve had a child before, lightening usually occurs just before labor.

In addition to aching or pressure in the perineal area, you may feel sharp twinges when the fetal head presses on the pelvic floor.

Prevention and self-care Kegel exercises can help strengthen your perineal muscles, and they may help with the aching. To do Kegels, squeeze the muscles around your vagina tightly, as if you were stopping the flow of urine for a few seconds, then relax. Repeat 10 times. For more on Kegels, see Kegel exercises in Chapter 12.

When to seek medical help If perineal aching or pressure grows stronger and is accompanied by a feeling of tightening or contractions, you may be in labor. Contact your care provider.

PERSPIRATION

The effects of pregnancy hormones on your sweat glands, along with your need to get rid of all the heat the baby produces, may leave you feeling a little damp. Increased perspiration during pregnancy makes heat rashes more common. Hot summer weather also can be quite trying in late pregnancy.

Prevention and self-care To relieve excessive perspiration, rest, drink cold liquids and take cool showers to avoid overheating.

PUBIC BONE PAIN

Some pregnant women are troubled by pain in the pubic bone. The sensation may be mild or sharp and feel like an ache or a bruise. The pain is caused by softening and loosening of your tissues and joints. As the cartilage that connects the two pubic bones in the center of your pelvis softens, your pubic bone may feel very sore when you’re moving or walking. Some pregnant women feel this more than others, and some have it only later in their pregnancies. Pubic bone pain should disappear within a few weeks after you give birth.

Prevention and self-care To ease the discomfort of pubic bone pain, you might try wearing support pantyhose. It may also help to take a warm bath. Alternating heat and cold may provide pain relief.

When to seek medical help Very rarely, pubic bone pain may result from joint inflammation. In this situation, the pain is constant, gets worse and may be accompanied by fever. If these signs and symptoms develop, contact your care provider.

RASHES

Red, itchy skin is probably not the pregnancy glow you had in mind. But some women develop rashes during pregnancy. Heat rashes, sometimes called prickly heat, are most common. They’re caused by the increased perspiration and dampness triggered by pregnancy hormones. Other types of rashes also may appear during pregnancy.

 Intertrigo. This rash may result from inflammation due to skin rubbing, a bacterial infection or a fungal infection in the skin folds. It’s typically found in the sweaty skin folds under the breasts or in the groin area — warm, moist areas where fungi can thrive. Intertrigo should be treated as early as possible because the longer it continues, the more difficult it may be to treat.

 PUPPPs. About 1 in every 150 pregnant women develop a severe rash with the tongue-twisting name pruritic urticarial papules and plaques of pregnancy (PUPPPs). This condition is characterized by itchy, reddish, raised patches on the skin. These itchy bumps are called papules, and the larger raised areas are called plaques. They usually show up first on the abdomen and often spread to the arms, legs and buttocks. In some women, the itching can be extreme. Although PUPPPs can be miserable for the mother, it doesn’t pose risks to the baby. The rash should go away after you deliver. Although it’s not known for certain what causes PUPPPs, a genetic factor appears to be involved because the condition tends to run in families. PUPPPs is more common in first pregnancies, and it rarely recurs in later ones.

Prevention and self-care Most common rashes will improve with gentle skin care. Avoid scrubbing the skin, and use gentle cleansers. Minimize the use of soap. Oatmeal baths or baking soda baths can help relieve itchiness. Heat rash can be soothed by applying cornstarch after bathing, avoiding very hot baths or showers, and keeping the skin cool and dry.

To help prevent intertrigo, wear loose-fitting cotton clothing, wash and dry the affected areas frequently — use a gentle cleanser or unscented soap — and apply calamine lotion, baking soda or zinc oxide powder to the affected areas. You can also try blowing a fan or hair dryer on its lowest setting across moist areas.

Medical care If self-care measures are ineffective or if your rash persists, worsens or is accompanied by other symptoms, let your care provider know. In some cases, treatment with a medicated cream or oral drug may be necessary.

RECTAL BLEEDING

Rectal bleeding always requires evaluation. Most often rectal bleeding is caused by hemorrhoids, which are fairly common during the last trimester and in the weeks following delivery. Another possible cause of rectal bleeding is a tiny crack or cracks in the anus (anal fissure). Fissures are usually caused by constipation, another common problem during pregnancy. Anal fissures are usually quite painful, especially during passage of hard stool. Only rarely is rectal bleeding related to a serious colorectal disorder.

Prevention and self-care To prevent constipation, your best strategy is to stay regular.

When to seek medical help Always report rectal bleeding to your care provider. He or she will want to determine the cause of the bleeding. Bleeding accompanied by diarrhea with mucus and abdominal pain may indicate the possibility of an inflammatory bowel disorder.

RED PALMS AND SOLES

Two-thirds of pregnant women find that during pregnancy their palms and the soles of their feet become red. This skin change is more common in white women than in black women. The redness can appear as early as the first trimester and is generally the result of increased blood flow to the hands and feet. In addition to being red, these areas may itch. Like most skin changes of pregnancy, the redness fades after delivery.

Prevention and self-care If your hands and feet itch, moisturizing creams may help.

When to seek medical help If the redness doesn’t fade after delivery, talk to your care provider.

RIB TENDERNESS

In the later months of pregnancy, the fetus runs out of room to stretch and may find it handy to rest his or her feet between your ribs. It’s surprising how much those little toes and feet jamming into your rib cage can hurt.

In addition to the pressure the baby is exerting, the shape of your chest is being altered to maintain room for your lungs while the diaphragm is pushed upward by the uterus. This reshaping pushes your ribs outward and can lead to pain between the ribs and the cartilage that attaches them to your breastbone.

If the baby’s position is hurting your ribs, take a deep breath while raising one arm over your head, then exhale while you drop your arm. Repeat this movement a few times with each arm. Gently pushing the baby’s feet or bottom away from the painful side also is quite safe. You can also try this stretch. Get down on your hands and knees, with your back relaxed but not sagging. Keeping your head straight and your neck aligned with your spine, round your back upward toward the ceiling. Allow your head to drop all the way down. Gradually release your back and raise your head to the original position. Repeat several times.

Rib tenderness may disappear after the baby drops into your pelvis, which usually happens two to three weeks before delivery in first pregnancies — but usually not until labor begins in subsequent ones.

ROUND LIGAMENT PAIN

One of several ligaments that holds your uterus in place within your abdomen, the round ligament is a cord-like structure that’s less than a quarter of an inch thick before pregnancy. At that time, your uterus is about the size of a pear. Stretching the round ligament can cause pain in the abdomen, pelvis or groin during the second and third trimesters.

As the uterus grows in size and weight, the ligaments supporting it become longer, thicker and more taut, stretching and tensing like rubber bands. If you move or reach suddenly, the round ligament can stretch, causing a pulling or stabbing pang in your lower pelvic area or groin or a sharp cramp down your side.

Round ligament pain can be severe, but the discomfort usually goes away after several minutes. You may wake up at night with this type of pain after rolling over in your sleep. The pain may also be triggered by exercise. Round ligament pain may ease as your pregnancy progresses. It should go away after you have your baby.

Prevention and self-care Although round ligament pain is uncomfortable, it’s normal with pregnancy. The following suggestions may provide relief:

 Change the way you move. Sit down and get up more slowly, and avoid sudden movements.

 Sit or lie down when abdominal pain becomes bothersome.

 Apply heat by soaking in a warm bath or using a heating pad on a low setting.

When to seek medical help If you’re not sure of the cause of your abdominal pain, and the pain is persistent and severe, call your care provider. Contact your care provider right away or go to a hospital emergency department if abdominal pain is accompanied by fever, chills, pain when urinating or vaginal bleeding.

SENSITIVITY TO SMELLS

You normally love the smell of bacon cooking and coffee brewing, but now that you’re pregnant these odors make you gag. Your co-worker’s perfume makes you feel sick, and you have to fight off nausea when you fill up the gas tank. Research confirms that pregnant women have a sharper sense of smell — they notice odors that they don’t normally notice, and previously acceptable smells become repugnant. This heightened sense of smell is also connected to the nausea and vomiting that many pregnant women experience. A variety of odors, such as foods cooking, coffee, perfume, cigarette smoke or particular foods, can trigger nausea.

A sensitive sense of smell may be due in part to the increase in estrogen during pregnancy. Like nausea, this symptom may indicate a rapidly growing placenta and embryo, and that’s a good sign. Most women find this symptom to tightly parallel nausea in pregnancy, so it usually improves by 13 to 14 weeks.

Prevention and self-care To keep your overactive olfactory cells from getting the best of you, be aware of the odors that trigger or aggravate your nausea, and avoid them whenever possible. You might have to eat lunch at your desk instead of the cafeteria. Or you may have to ask a co-worker not to wear a particular perfume or cologne until your nausea subsides.

SHORTNESS OF BREATH

Having trouble catching your breath? Many pregnant women experience mild breathlessness beginning in the second trimester. This is because your expanding uterus is pushing against your diaphragm — the broad, flat muscle that lies under your lungs. The diaphragm rises about 1½ inches from its usual position during pregnancy. That may seem like a small amount, but it’s enough to crowd your lungs and alter the amount of air your lungs are able to take in.

At the same time, your respiratory system makes some adaptations to allow your blood to carry large quantities of oxygen to the placenta and to remove more carbon dioxide than normal. Stimulated by the hormone progesterone, the respiratory center in the brain causes you to breathe more deeply and more frequently. Your lungs will inhale and exhale 30 to 40 percent more air with each breath than they did before. These changes may give you the feeling that you’re breathing hard or short of breath.

The larger your uterus becomes, the harder you may find it to take a deep breath because your diaphragm is pushing against the baby. A few weeks before you give birth, the baby’s head may move down in the uterus (drop), taking the pressure off the diaphragm. When the baby drops, you’ll find it easier to breathe. But this may not happen until the start of labor, especially if you’ve had a baby before.

Despite the discomfort of feeling short of breath, you don’t have to worry that your baby isn’t getting enough oxygen. Thanks to your expanded respiratory and circulatory systems, the oxygen level in your blood increases during pregnancy, ensuring that your growing baby is getting plenty of oxygen.

Prevention and self-care If you’re short of breath, try these tips:

 Practice good posture. It will help you to breathe better, both during pregnancy and afterward. Sit and stand with your back straight and shoulders back, relaxed and down.

 Do aerobic exercise. It will improve your breathing and lower your pulse rate. But take care not to overexert yourself. Talk to your care provider about a safe exercise program for pregnancy.

 Sleep on your side to help lessen the pressure on your diaphragm. Prop yourself up with pillows that support your abdomen and your back, or use a body pillow.

When to seek medical help Mild shortness of breath is common in pregnancy, but severe shortness of breath, especially if it’s accompanied by chest pain, may indicate a more serious problem, such as a blood clot in a lung.

Call your care provider immediately or go to an emergency room if you have:

 Severe shortness of breath along with chest pain

 Discomfort while taking a deep breath

 Rapid pulse or rapid breathing

 Bluish-colored lips or fingertips

SKIN TAGS

During pregnancy, you may discover a few new skin growths under your arms, on your neck or shoulders, or elsewhere on your body. These tiny, loose protrusions of skin, called skin tags, are usually painless and harmless. They typically don’t grow or change. No one knows what causes them. They often disappear after you give birth. But they’re common after midlife.

Generally, skin tags aren’t bothersome and don’t require treatment. If the growths are irritating or cosmetically displeasing, they can easily be removed. Let your care provider know if a skin growth changes in appearance.

SNORING

Pregnant women are more likely to snore because the upper airway is narrower, due to increased swelling in the nasal passages and nasal congestion during pregnancy.

Although snoring is often the subject of jokes, it can have some serious consequences. Snoring can be related to high blood pressure (hypertension). It may also be a sign of sleep apnea, a sleep disorder in which you stop breathing for short periods during sleep. The lack of oxygen disrupts the mother’s sleep and may stress the fetus.

Overweight women may be at particularly high risk of snoring-related problems. In one study, women who reported regular snoring during pregnancy were heavier before becoming pregnant and gained more weight during pregnancy.

Prevention and self-care To minimize your chance of snoring:

 Sleep on your side rather than your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway.

 Nasal strips may help increase the area of your nasal passages and airway.

 Keep your weight gain in check. Avoid gaining more than recommended based on your pre-pregnancy weight.

When to seek medical help Contact your care provider if your partner thinks your snoring is interrupted by periods of stopped breathing, and you find yourself excessively sleepy during the day. These signs may indicate obstructive sleep apnea.

STRETCH MARKS

Get a group of new or expecting moms together, and you’re likely to hear something about stretch marks. Stretch marks are pink or purplish streaks that typically appear on the abdomen, breasts, upper arms, buttocks and thighs. About half of pregnant women get them, especially during the last half of pregnancy.

Stretch marks aren’t a sign of excessive weight gain. They’re caused by a stretching of the skin along with a normal increase in the hormone cortisone, produced by the adrenal glands. The increase in cortisone can weaken elastic fibers of the skin, causing the marks. Heredity is also believed to play a big role in the development of stretch marks. Some women experience severe stretch marks even though they gain only a small amount of weight during their pregnancies.

Stretch marks usually don’t disappear altogether, but after delivery they often fade gradually to light pink or white.

Prevention and self-care Contrary to popular belief, no creams or ointments can prevent stretch marks or make them vanish. Because stretch marks develop from deep within the connective tissue underneath the skin, they can’t be prevented by anything applied externally.

STUFFY NOSE

Nasal stuffiness is a common problem in pregnancy, even if you don’t have a cold or allergies. Nasal congestion and nosebleeds are more frequent because of the increased flow of blood to the mucous membranes in your body. As the lining of your nose and airway swells, your airway shrinks. Your nasal tissue also becomes softer and more prone to bleeding. This nasal stuffiness is common in pregnancy, but can be annoying.

Prevention and self-care Most pregnant women can tolerate a stuffy nose and other nasal symptoms without taking medications. If there’s no accompanying problem such as a cold or allergies, no treatment is generally required. These tips may help keep your stuffy nose clearer:

 Use a humidifier in your home to loosen nasal secretions.

 Place a towel over your head and breathe the steam from a pan of water.

 Sleep propped up with your head elevated.

Medical care Avoid over-the-counter remedies for your stuffed-up nose. Prolonged use of these medications can cause problems, and your nasal stuffiness could last for the full length of your pregnancy. Try to deal with the stuffiness using conservative treatments. For additional tips on dealing with nasal congestion related to inflammation, see How do I treat allergies? in Chapter 2.

SWELLING

Swelling (edema) is common during pregnancy when your body tissues accumulate more fluid due to dilated blood vessels and increased blood volume. Warm weather also can aggravate the condition.

During the last three months of pregnancy, about half of pregnant women notice their eyelids and face becoming puffy, mostly in the morning. This is due to fluid retention and dilated blood vessels, which are expected in pregnancy. In the last few weeks of pregnancy, almost all women have some swelling in their ankles, legs, fingers or face. By itself, swelling is annoying but not a serious complication.

Prevention and self-care If you have problems with swelling:

 Use cold-water compresses on swollen areas.

 Ease off extremely salty foods, but you don’t need to cut back dramatically on salt. Doing so can cause your body to conserve sodium and water, which can make swelling worse.

 To relieve swelling in your legs and feet, lie down and elevate your legs for an hour in the middle of the afternoon. Using a footrest also may help.

 Swimming or even standing in a pool may provide some relief. Water pressure will compress your ankles, and your uterus will float just a bit, easing the pressure on your veins.

When to seek medical help If you experience a sudden swelling of your face and hands — especially if you find you aren’t urinating as often as usual — contact your care provider immediately. Swelling in the face, especially around the eyes, may occasionally be a sign of preeclampsia.

SWOLLEN FEET

During pregnancy it’s common for your feet to swell. Hormonal changes that relax the ligaments and joints in your pelvis in preparation for delivery also relax all the other ligaments and joints in your body, including those in your feet. While these changes are normal and necessary, they can make the arch ligament of the foot stretch under your body’s extra weight. As a result, the arch may lose some of its supporting strength, and your feet grow flatter and wider. They may be as much as a full shoe size larger.

On top of these changes, your feet may swell due to fluid retention during pregnancy. If your weight gain is significant, your feet may carry a little extra fat.

The swelling in your feet should go down shortly after delivery. But it can take up to six months for the other changes in your feet to reverse themselves and your feet to return to their normal size and shape. If your arch has been stretched excessively, your feet may be permanently larger.

Prevention and self-care As your feet expand, wear shoes that will provide comfort and support. Buy a couple of pairs of shoes that fit you well now and will remain comfortable if your feet continue to change. Avoid narrow-toed or high-heeled shoes. Look for low heels, nonskid soles and plenty of space for your feet to spread out.

Canvas or leather shoes are good choices because they allow your feet to breathe. Good running shoes are a wise choice. If your feet are aching and tired at the end of the day, try wearing supportive slippers.

Medical care Some shoes and orthotic inserts are specially designed for pregnancy. They’re meant to make your feet more comfortable and reduce back and leg pain. Ask your care provider for more information.

THIRST

You may notice you’re thirstier than normal while you’re pregnant. That’s perfectly healthy. Increased thirst is your body’s way of getting you to drink more water and other fluids. Your body needs extra fluids to maintain your increased blood volume. Drinking more fluids also helps prevent constipation and dry skin and helps your kidneys dispose of the waste products being produced by the fetus.

Prevention and self-care Drink at least eight glasses a day of water or other beverages. Caffeinated beverages stimulate urine production, so they aren’t the best choice. In addition to plain or sparkling water, good choices include a fruit juice fizz made with half juice and half sparkling water, vegetable juice, soup and a fruit shake made with skim milk. You have many good choices for fluid replenishment in pregnancy. If you’ve been vomiting or you’ve had trouble with feeling faint, sports drinks may be good.

When to seek medical help Although increased thirst is normal when you’re expecting, it can also be a symptom of diabetes. It’s possible to develop diabetes during pregnancy. It can be hard to distinguish the subtle signs and symptoms of diabetes, such as fatigue, excessive thirst or excessive urination, from the typical changes of pregnancy.

URINARY TRACT INFECTIONS

Many of the normal changes of pregnancy can increase your risk of urinary tract infections (UTIs) — infections of the bladder, kidney or urethra. It’s very important to recognize and treat UTIs during pregnancy because such infections can lead to preterm labor. What’s more, UTIs during pregnancy are more likely to be severe. For example, if you have a bladder infection that goes untreated, it may result in a kidney infection.

You’re also more susceptible to UTIs after giving birth. For a time after delivery, you may be unable to empty your bladder completely. The urine that’s left provides a breeding ground for bacteria.

If you have a UTI, you may feel pain or burning when you urinate. You might feel a frequent, almost panicky urge to go, or you might feel like you need to go again right after you’ve urinated. Other signs and symptoms include blood in the urine, strong-smelling urine, mild fever and tenderness over the area of the bladder. Abdominal pain and backache also may signal an infection.

Prevention and self-care You can prevent and help clear up UTIs in several ways:

 Drink plenty of liquids, especially water.

 Urinate often — don’t hold it or wait for long periods of time before you go. Holding in your urine can result in incomplete emptying of the bladder, which can lead to a UTI. Frequent urination is also helpful in clearing up a UTI.

 Lean forward while you urinate to help empty your bladder more fully.

 Always urinate after having sexual intercourse.

 After you urinate, wipe from front to back.

Medical care A urinary tract infection is diagnosed by testing a urine sample for bacteria. Treatment includes antibiotics to clear up the infection. If you’ve had several UTIs, your care provider might recommend that you continue taking antibiotic medication to lessen the chance of recurrence.

URINATING FREQUENTLY

During the first trimester of pregnancy, your growing uterus pushes on your bladder. As a result, you may find yourself running to the bathroom more often than usual. You may also leak a small amount of urine when you cough, sneeze or laugh. By the fourth month, the uterus expands up out of the pelvic cavity, easing pressure on the bladder. Then, in the last few weeks of pregnancy, you may need to urinate more frequently again, when the baby’s head drops into the pelvis, placing renewed pressure on the bladder. Frequent urination almost always goes away after you give birth.

Prevention and self-care The following suggestions may help:

 Urinate as often as you need to. Holding in your urine can result in incomplete emptying of the bladder, which can lead to a urinary tract infection.

 Lean forward when you urinate to help empty your bladder more fully.

 Avoid drinking anything a few hours before bedtime so that you don’t have to get up as often during the night. Make sure you’re still getting plenty of fluids during the rest of the day.

When to seek medical help If you’re urinating frequently and are also experiencing burning, pain, fever, or a change in the odor or color of your urine, you may have a urinary tract infection. Contact your care provider.

URINE LEAKAGE

Sometimes, pregnant women and new mothers pass urine involuntarily, especially when coughing, straining or laughing. That’s because during pregnancy the baby is often resting directly on your bladder, and no one can stay dry with a baby bouncing on her bladder. Sometimes, damage at birth to the pelvic floor muscles and nerves to the bladder will cause urine leakage for a few weeks after birth. Fortunately, this problem usually improves within three months of giving birth. Unfortunately, the problem tends to recur later in life.

Prevention and self-care Research shows that doing Kegel exercises may help prevent urinary incontinence during pregnancy and after childbirth. These strengthening exercises help form a stronger, thicker support for your bladder, urethra and other pelvic organs. To do Kegel exercises, squeeze the muscles around your vagina tightly, as if you were stopping the flow of urine, for a few seconds, then relax. Repeat 10 times.

If you experience incontinence, wear panty liners or other protective undergarments.

VAGINAL BLEEDING

As many as half of all pregnant women may experience spotting or vaginal bleeding at some point during their pregnancies, especially in the first trimester. Vaginal bleeding in pregnancy has many causes — some are serious and some aren’t. The significance and possible causes of bleeding are different in each trimester.

First trimester Many women have spotting or bleeding in the first 12 weeks of pregnancy. Depending on whether it’s heavy or light, how long it lasts, and if it’s continuous or sporadic, bleeding can indicate many things. It may be a warning sign, but it may also be due to the normal events of pregnancy.

You may notice a small amount of spotting or bleeding very early in your pregnancy, about a week to 14 days after fertilization. Known as implantation bleeding, it happens when the fertilized egg attaches to the lining of the uterus. This type of bleeding usually doesn’t last long.

Bleeding in the first trimester can also be a sign of a miscarriage. Most miscarriages take place during the first trimester. They occur less frequently later in pregnancy. However, bleeding doesn’t necessarily mean you’re having a miscarriage. At least half the women who bleed in the first trimester don’t experience miscarriages.

Another problem that can cause bleeding and pain in early pregnancy is ectopic pregnancy, a condition in which the embryo implants itself outside the uterus, usually in a fallopian tube (see ectopic pregnancy in Chapter 30). An uncommon cause of bleeding in the first trimester is molar pregnancy, a rare condition in which an abnormal mass, instead of a baby, forms inside the uterus after fertilization (see molar pregnancy in Chapter 30).

Second trimester Although miscarriage is less common in the second trimester, a risk still exists. Vaginal bleeding is the primary sign of miscarriage.

Moderate to heavy bleeding in the second trimester may also indicate a problem with the placenta. Placental problems may include placenta previa, in which the placenta lies too low in the uterus and partly or completely covers the cervix, or placental abruption, in which the placenta begins to separate from the inner wall of the uterus before birth. Both of these conditions are more frequent in the third trimester.

A cervical infection, an inflamed cervix or growths on the cervix also can cause vaginal bleeding. Cervical bleeding is usually not a risk to the baby, but if it’s caused by cervical cancer, it’s very important that the diagnosis be made promptly. Occasionally, bleeding from the cervix may be a sign of cervical incompetence, a condition where the cervix opens spontaneously, leading to preterm delivery. Light bleeding or spotting during intercourse can also occur if vessels on the surface of the cervix are disrupted. This is not harmful to the pregnancy.

Third trimester Vaginal bleeding in the late second or third trimester may be a sign of a problem with the placenta. In placental abruption, the placenta begins to detach from the inner wall of the uterus. Bleeding may be nonexistent, heavy or somewhere in between.

In placenta previa, the cervix is partly or completely blocked by the placenta, which is normally located near the top of the uterus. The main sign of placenta previa is painless vaginal bleeding, typically near the end of the second trimester or the beginning of the third. The blood from placenta previa is usually bright red. The bleeding may be scant but is usually fairly heavy. It may stop on its own, but the bleeding nearly always returns days or weeks later.

Light bleeding from weeks 20 to 37 may indicate preterm labor. Bleeding in the last weeks of pregnancy may be a sign of impending labor. The mucous plug that seals the opening of the uterus during pregnancy may be expelled a few weeks before labor or at the start of it. The discharge may include a small amount of blood.

When to seek medical help Any bleeding during pregnancy should be evaluated by your care provider. Contact your care provider if you have slight spotting or bleeding, even if it goes away within a day. Contact him or her immediately or go to a hospital emergency room if you have:

 Bleeding in the second or third trimester

 Moderate to heavy bleeding

 Bleeding accompanied by pain, cramping, fever, chills or contractions

Treatment will depend on the cause. For more information on placental abruption and previa, see placental problems in Chapter 27.

VAGINAL DISCHARGE

Many women have increased vaginal discharge throughout pregnancy. This discharge, called leukorrhea, is thin, white and mild smelling or odorless. It’s caused by the effects of hormones on the vaginal lining, which must grow dramatically during the pregnancy. Vaginal discharge may increase throughout the pregnancy, becoming quite heavy. The high acidity of the discharge is thought to play a role in suppressing growth of harmful bacteria.

You’ll also have temporary vaginal discharge after giving birth. This discharge, called lochia, is caused by hormone shifts and varies in amount, appearance and duration. Initially it’s bloody, then it becomes paler or brownish after about four days and white or yellowish after about 10 days. You may occasionally pass a blood clot. This post-pregnancy discharge can last from two to eight weeks.

Vaginal discharge may also be a sign of a vaginal infection. If your vaginal discharge is greenish, yellowish, thick and cheesy, strong smelling or accompanied by redness, itching or irritation of the vulva, you may have a vaginal infection. Bacterial vaginosis is a common type of vaginal infection. It causes a foul-smelling gray to greenish discharge, and may be associated with preterm labor. Two other common types of vaginal infection during pregnancy are candidiasis and trichomoniasis. Neither presents a direct hazard to your baby, and both can be treated during pregnancy.

A steady or heavy watery discharge may be a sign that your membranes have ruptured — your water has broken. A vaginal discharge that’s bloody or thick and mucus-like may indicate a problem with the cervix.

Prevention and self-care To deal with the normal increased discharge of pregnancy, you might want to wear panty liners or a light sanitary pad. To reduce your risk of getting an infection:

 Don’t douche. Douching can upset the normal balance of microorganisms in the vagina and can lead to a vaginal infection called bacterial vaginosis.

 Wear cotton underwear.

 Wear comfortable, loosefitting clothing. Avoid fabrics that don’t breathe, tight slacks, exercise pants and leotards.

When to seek medical help Contact your care provider if:

 You have abdominal pain or fever with a discharge.

 The discharge becomes greenish, yellowish or foul smelling; or is thick and cheesy or curd-like; or is bloody.

 The discharge is accompanied by soreness, redness, burning or itching of the vulva.

 You have a steady or heavy discharge of watery fluid.

 You’ve just had amniocentesis, and you have an increased vaginal discharge. This could indicate an amniotic fluid leak.

If you’ve already given birth, call your care provider in the following situations:

 You’re soaking a sanitary napkin every hour for four hours. Don’t wait the four hours if you become dizzy or notice increasing blood loss. Call right away or go to the emergency room.

 The discharge has a foul, fishy odor.

 The discharge is accompanied by fever and abdominal pain.

 Your abdomen feels tender or you’re passing numerous blood clots.

VARICOSE VEINS

The circulatory changes that support the growing fetus during pregnancy can also produce the unfortunate side effect of varicose veins. It’s not uncommon to develop varicose veins during pregnancy. To accommodate increased blood flow during pregnancy, blood vessels often become larger. At the same time, blood flow from your legs to your pelvis may be slowed. This can cause the valves in the veins in your legs to fail, leading to dilated, bulging veins. Varicose veins tend to run in families. An inherited weakness in the valves of your veins can make you more susceptible.

Varicose veins may cause no symptoms, or they may be painful or uncomfortable, causing sore, aching legs, sometimes accompanied by a burning sensation. The size of the veins usually decreases somewhat after birth.

Prevention and self-care These measures can help prevent varicose veins, keep them from getting worse or ease their discomfort:

 Avoid standing for long periods.

 Don’t sit with your legs crossed. Doing so can aggravate circulatory problems.

 Elevate your legs as often as you can. When you’re sitting, rest your legs on another chair or a stool. When lying down, raise your legs and feet on a pillow.

 Exercise regularly to improve your overall circulation.

 Wear support stockings from the time you wake up until you go to bed. These stockings help improve the circulation in your legs. Ask your care provider to recommend a good brand.

 Wear loose clothing around your thighs and waist. Socks and tight clothing on the lower legs are fine, but don’t wear clothes that constrict the upper legs, such as underwear with tight openings. This can impede the return of blood from your legs and worsen varicose veins.

Medical care Varicose veins generally don’t require treatment. In severe cases, they may need to be treated surgically, but the procedure isn’t normally done until after delivery.

VOMITING

Nausea and vomiting are common during early pregnancy and can occur at any time of day (see coping with morning sickness in Chapter 5). But sometimes vomiting becomes so severe that a pregnant woman can’t eat or drink enough to maintain proper nutrition and stay hydrated. This condition, called hyperemesis gravidarum, is the medical term for excessive vomiting in pregnancy.

Hyperemesis gravidarum is characterized by vomiting that’s frequent, persistent and severe. You may also feel faint, dizzy or lightheaded. If not treated, hyperemesis can keep you from getting the nutrition and fluids you need, and you may become dehydrated. Rarely, the loss of fluids and salts from vomiting can be severe enough to threaten the fetus.

The exact causes of hyperemesis aren’t known, but it seems to occur more frequently when the pregnancy hormone human chorionic gonadotropin (HCG) is very high, as in a multiple pregnancy or a molar pregnancy. A molar pregnancy is a rare condition in which an abnormal mass rather than a baby forms inside the uterus. Hyperemesis is more common in first pregnancies, young women and women carrying multiple fetuses.

Prevention and self-care If you’re vomiting only occasionally or about once a day, follow the self-care measures listed under morning sickness.

When to seek medical help Contact your care provider if:

 You have nausea and vomiting so severe you can’t keep food or fluids down

 You’re vomiting more than two or three times a day

 Vomiting persists well into the second trimester

 You have some of the signs and symptoms of early or mild dehydration, which include a flushed face, extreme thirst, dizziness, leg cramps, headache and dark yellow urine.

YEAST INFECTIONS

Yeast infections (candidiasis) are caused by the organism Candida albicans, which is found in small amounts in the vagina in about 25 percent of women. Increased estrogen levels during pregnancy cause changes in the vaginal environment, which may throw off the natural balance and allow some organisms to grow faster than others.

Candida may be present without causing signs and symptoms, or it may cause an infection. Signs and symptoms of infection include a vaginal discharge that is thick, white and curd-like, itching, burning and redness around the vagina and vulva, and painful urination.

Although a yeast infection is unpleasant for you, it won’t hurt your baby, and it can safely be treated during pregnancy.

Prevention and self-care To help prevent yeast infections:

 Wear underwear or pantyhose with cotton crotches, as well as loose-fitting pants.

 Avoid wearing wet bathing suits or exercise clothes for long periods of time, and wash them after each use.

 Eat yogurt that contains live Lactobacillus acidophilus cultures — most yogurt does. Yogurt may help keep the right mix of bacteria flourishing in your body.

Medical care Candidiasis is treated during pregnancy with a vaginal cream or a suppository containing an antifungal cream. These medications are available without a prescription, but don’t use one without consulting your care provider first. Your care provider needs to confirm the diagnosis before you start treatment. He or she may also recommend a prescription medication to clear the infection.

Once you’ve had a yeast infection while pregnant, it can be a recurring problem until after delivery, when it usually subsides. It may be necessary to treat yeast infections repeatedly throughout your pregnancy.